East Anglian Air Ambulance - Norwich Base is operated by East Anglian Air Ambulance (EAAA) and is a registered charity. It provides a helicopter emergency medical service (HEMS) and rapid response vehicle from its air base in Norwich. The service responds to demands from the local NHS ambulance trust emergency control room, where critical care paramedics triage emergency 999 calls and liaise with EAAA to deploy the most appropriate resource.

We inspected this service using our comprehensive inspection methodology. We carried out an announced inspection on 5 February 2018.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led?

Throughout the inspection, we took account of what people told us and how the service understood and complied with the Mental Capacity Act 2005.

The main service provided by this service was emergency and urgent care.

Services we do not rate

We regulate independent ambulance services but we do not currently have a legal duty to rate them. We highlight good practice and issues that services need to improve and take regulatory action as necessary.

We found the following areas of good practice:

• The provider promoted a positive culture of learning and development. This included learning from incidents, encouraging staff development, promoting high standards of clinical knowledge, and increasing understanding of prehospital emergency medicine on patient survival rates.

• Staff maintained emergency equipment, medication, consumables, the air ambulance, and the rapid response vehicle to a high standard so the vehicles were ready for rapid deployment to emergencies.

• The registered manager ensured policies and standard operating procedures, were comprehensive and reviewed in line with set review dates. The provider had embedded processes for maintaining patient safety, for example safeguarding and complaints and staff knew how to respond to and escalate any safeguarding concerns.

• There were effective systems in place to monitor service delivery and to improve performance, these included monitoring patient outcomes, and response times. The provider was part of local and regional networks to share performance data, adopt innovation, and quality improvement was at the heart of the service.

• The provider had established governance systems to monitor incidents, risk, and quality. Risk was owned at all levels of the organisation and managed appropriately, with key time scales and mitigating actions to reduce any adverse impact on the service, staff, and patients.

• Patient and stakeholder feedback was universally positive, with examples of staff going the extra mile to provide a service that was caring, responsive and met the needs of the local population.

• The provider had a clear mission, vision, and five-year development strategy focused on meeting the needs of the local population, enhancing staff training, skills, and knowledge whilst promoting innovation in prehospital emergency medicine.

• Staff universally described a positive working culture focused on providing patients with high standards of care, promoting team working with high levels of respect for colleagues and the leaders within the service.

• The service promoted the health and welfare of staff in innovative ways, including additional training in relation to promoting wellbeing, dealing with mental health and celebrating staff success.

• Staff described managers as highly approachable, supportive, and caring. The provider used innovative ways to promote staff wellbeing. A dedicated aftercare service for patients enabled staff to engage with the patient and discuss what happened to them as part of their recuperation.

• During our inspection, we found high levels of engagement with the service’s vision and strategy, led by the trustees and senior management team, and supported by the operational team, fundraising and volunteer staff.

Heidi Smoult

Deputy Chief Inspector of Hospitals on behalf of the Chief Inspector of Hospitals

Staff spoken with described how people were supported during their treatment episode. This showed us that people’s privacy, dignity and independence were respected by this service.

The provider’s ‘standard operating procedures’ used for all their emergency care and treatments reflected the national guidance issued by the United Kingdom Resuscitation Council and the Joint Royal College Ambulance Liaison Committee (JRCALC). This demonstrated to us that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

Staff spoken with outlined their roles and responsibilities around working collaboratively in the best interests of the person who needed emergency treatment. This and the other evidence seen showed us that people who required emergency treatment were protected because the provider worked in co-operation with others.

The provider ensured that staff were recruited appropriately and then fully supported in their role within the service. This meant that people who required emergency care received this from suitably qualified and skilled staff.

All of the records kept by the service were seen to be accurate and fit for purpose. This meant that people were protected from the risks of unsafe or inappropriate care and treatment because appropriate records were maintained.

We did not speak with people using the service during this inspection. However, the East Anglian Air Ambulance patient survey addressed questions about patients’ experience of receiving care and treatment. Survey reports showed that responses to questions about how pain relief was provided, the quality of staff, the cleanliness of vehicles and overall satisfaction with care and treatment were all positive. One patient had responded saying that they had found it noisy in the helicopter and they could have felt isolated. However, they also said that they valued the “human touch” that staff had offered.

Staff routinely sought verbal consent from patients who were able to give it. Where patients were unconscious or unable to make such a decision, staff acted in their best interests. Patients were assessed and their clinical management was planned and delivered according to their assessed need.

We found that all areas were clean and that effective arrangements were in place to prevent and control the spread of infection.

Staff received appropriate support, including supervision, appraisal and training. However, the arrangements for the appraisal of locum doctors were still being developed.

The arrangements to monitor and ensure the quality and safety of the service were effective.